Putting medical research to the test

There is evidence to suggest that cancer screening is nowhere near as effective as the public is led to believe. Meanwhile, MS patients have been warned against a controversial new treatment developed in Italy.

Chronic ulcers, on the other hand, have been all but eradicated because of a discovery that has only recently gained wide acceptance.

What do these otherwise unrelated topics have in common?

They illustrate the slow and often complex path that leads medical research either to a successful conclusion or to a hopeless dead end.

Prostate cancer and PSA

In Monday’s Globe and Mail, André Picard reported on new findings issued by the U.S. Preventive Services Task Force that advise against regular blood tests for men to screen against prostate cancer. The test, which looks for the prostate specific antigen (PSA), has already proven to be unreliable, and many Canadian provinces have abandoned regular screening.

But as Picard suggests, old habits die hard in the medical community. He expects a lot of pushback to the report.

“The reaction to come is easy to predict: it will be denounced and largely ignored, an echo of what occurred when similar recommendations were made about breast-cancer screening,” he wrote.

Other examples

In November 2011, a similar Canadian panel declared that the benefit of breast-cancer screening for women between 40 and 50 years of age is dubious at best. Yet this province, as one example, recently opened the doors to regular screening for this age group.

Critics of the panel findings argue that its math is inaccurate, and that technology has improved since the time from which data was collected.

Entrenched medical practices are hard to penetrate. And no one knows that better than Barry Marshall.

Ulcer solution

In Australia in 1981, Marshall teamed up with a pathologist, Robin Warren, who had discovered a form of a bacteria that seemed to reside in human stomachs.

At the time, the thought of bacteria surviving in such an acidic environment was preposterous.

But when Marshall and Warren finally succeeded in obtaining a culture of H. Pylori, they knew they were on to something.

Marshall battled for well over a decade to convince the medical community at large that this bacteria was the cause of stomach ulcers.

He was ridiculed by colleagues and ignored by the establishment. But by the 1990s, the evidence had become irrefutable.

Ulcers are now cured with a combination of antibiotics and antacids.

In 2003, Marshall and Warren were awarded the Nobel Prize for medicine.

No clear winner

The jury is still out, unfortunately, on a recent “miracle” treatment for multiple sclerosis. The so-called “liberation” treatment involves the surgical opening of blood vessels in the neck.

Although many patients have reported significant improvement, followup studies have found the results are mixed, and that the procedure carries risks of serious complications, even death.

Unlike the ulcer bacteria, therefore, the MS treatment may not prove to be the eureka moment everyone had hoped for, at least not in its current manifestation.

The lesson in all this is plain: medical practices are always changing, yet change does not come easy.

Promising revelations can sometimes crash and burn, while other radical, yet accurate findings face an uphill battle against the medical establishment.

Finding that uneasy balance between open-mindedness and healthy skepticism is one of the greatest challenges for medical research.

In the end, though, it is the science itself that inevitably prevails.

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Ava

May 23, 2012 - 11:22

"The Autism Enigma," a documentary featured on "The Nature of Things," talks about how autism may be caused by a bacteria imbalance in the gastrointestinal tract. Interesting stuff. And this research can't move ahead quickly enough for those of us who know anyone suffering with autism.